Department of Health and Social Care

Update on Reciprocal Healthcare Arrangements for Brexit

Edward Argar: Today I am notifying the House about an announcement that the Government has made about transitional healthcare arrangements across the EU if we are unable to secure a deal.The UK is leaving the European Union (EU) on 31 October 2019, with or without a deal. The UK Government is working hard to secure a deal that covers healthcare arrangements, but it is important that people understand what will happen if the UK leaves without a deal and what support the Government has put in place for that scenario.Our priority is to maintain reciprocal healthcare arrangements with Member States (MS) when we leave the EU. That is why the UK Government has proposed consistently to all MS that existing reciprocal healthcare arrangements (under Regulation 883) continue until 31 December 2020 in a no deal scenario. These arrangements safeguard healthcare for the hundreds of thousands of UK-insured persons who live in Europe or require medical treatment while holidaying in Europe. They also ensure that EU citizens can receive healthcare in UK, whether they are here on holiday, or to live and work.Regulation 883Current EU reciprocal healthcare arrangements (Reg (EC) No 883/2004) support large numbers of UK nationals living in, working in, or visiting the EEA or Switzerland to access healthcare. The arrangements require equal treatment between EU/EFTA citizens when accessing healthcare in other MS. Any EU citizen (or economically active third country national) resident in the UK who moves to the EEA or Switzerland can access state-provided healthcare by paying the same taxes as nationals of that country or people who are eligible for state healthcare.In addition, the UK reimburses other MS for the state-funded element of healthcare for certain groups known as ‘UK-insured’ who do not need to pay local taxes:(a) S1 – the UK covers the healthcare costs of S1 holders, which include state pensioners, people with disability benefits, certain workers and their dependents living in the EU.(b) European Health Insurance Card (EHIC) – the UK funds ‘needs-arising’ healthcare when UK residents visit the EU temporarily (for tourism, study or work).(c) S2 – the UK Government funds UK-insured individuals who travel to receive pre-authorised planned treatment in the EU (e.g. maternity).The UK administers reciprocal healthcare, including paying for overseas medical costs, on behalf of England, Scotland, Wales, Northern Ireland and Gibraltar.Arrangements with Member StatesArrangements are already in place with a number of MS, and the UK Government is still seeking further reciprocal agreements ahead of leaving the EU on 31 October. The Government is currently undertaking technical discussions with countries such as Belgium who have already passed domestic legislation that will support reciprocal healthcare with the UK after Brexit.The UK Government stands ready to reciprocate all arrangements with MS, and has the necessary legislation in place, under the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 and the European Union (Withdrawal) Act 2018.IrelandUnder the Common Travel Area (CTA), British citizens living in Ireland will be able to access healthcare in Ireland on the same basis as Irish citizens which means that they may need to make a financial contribution. The UK Government is in detailed discussions with the Irish Government to reach an arrangement which would enable current reciprocal healthcare arrangements to continue. British and Irish citizens who live in Ireland will also continue to have access to free-of-charge healthcare while visiting the UK. This is regardless of the circumstances in which the UK leaves the EU.SpainHealthcare access in Spain will remain the same after exit day, whatever the Brexit scenario. This is because the UK and Spain have each taken steps to ensure that people living in each country can continue to access healthcare as they do now until at least 31 December 2020, using their S1 forms. UK EHIC holders in Spain, and those who have planned treatment in Spain using an S2 form will also be able to continue to access healthcare in the same way when they are in Spain until at least 31 December 2020. The UK Government is now seeking to work closely with Spain to agree how this will work in practice. The Spanish government’s guidance on access to Spanish healthcare and Brexit can be found here: www.lamoncloa.gob.es/lang/en/brexit/Paginas/index.aspxSwitzerlandThe UK has reached an agreement with the Swiss Confederation to ensure that the rights of UK nationals living in Switzerland and Swiss nationals living in the UK are preserved in a no deal scenario after the UK leaves the EU on 31 October. This means that UK-insured individuals who reside in Switzerland at the time of Brexit will still be able to access healthcare using their S1 form, as they do now.Moreover, UK nationals travelling to Switzerland, before the UK leaves the EU will continue to be covered by their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit and end after the UK’s withdrawal from the EU. If a visit starts after the UK leaves the EU, EHIC may no longer be valid.Norway, Iceland and LiechtensteinThe UK has reached an agreement with the EEA-EFTA states (Iceland, the Principality of Liechtenstein, and the Kingdom of Norway) to ensure the rights of UK nationals living in these countries, and that nationals of Iceland, Liechtenstein and Norway living in the UK, by 1st November are preserved after the UK leaves the EU on 31 October 2019. This means that UK-insured individuals in these countries at the time of the UK’s exit will be able to access healthcare using their S1 form, as they do now, after 31 October.Moreover, UK nationals travelling to Iceland, Liechtenstein or Norway before the UK leaves the EU will continue to be able to rely on their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit but end after the UK has left the EU. If a visit starts after the UK has left the EU, EHIC may no longer be valid.Other EU CountriesUpdated information has been published on gov.uk and nhs.uk on the situation for each MS, including what arrangements have been put in place. These pages will be kept updated as further assurances from MS are received.Those living in the EU whose healthcare is funded by the UK should not delay in reviewing their circumstances in order to secure their future healthcare needs. It is important that people review their own needs now and consider options carefully by checking the guide for the country they live in. People can also sign up to email alerts to check these country guides regularly as the situation may change as the UK gets closer to leaving the EU.Preparing for Leaving the EUThe UK’s offer to EU citizens resident in the UK is clear. We offer complete assurance to EU citizens who are living in the UK on or before 31 October 2019, that they will be able to access free healthcare on the NHS after we leave the EU on 31 October. Should EU countries not agree to our offer to continue the existing reciprocal healthcare arrangements until December 2020, visitors from those EU countries will be charged for NHS care.Beyond the bilateral arrangements, it is difficult to predict what exact arrangements will be in place for UK nationals in other MS as we continue to hold our technical discussions with them. This is because of the varying nature of each country’s healthcare system. In view of this uncertainty, UK-insured individuals living in the EU should be ready for possible permanent changes to how they access healthcare.Everyone living in the EU is strongly encouraged to think about their own healthcare needs and circumstances and consider the steps they need to take to be assured of continuing healthcare coverage. The Government has produced detailed advice for each country which can be accessed here: www.gov.uk/uk-nationals-living-euSpecifically, individuals should consider: whether they need to register as a resident under local rules; the documentation they need to have in place; taking steps to understand how the local healthcare system operates and how their healthcare cover may change; and, if appropriate, purchasing private insurance.Contingency ArrangementsWhile we continue to promote our offer to all MS to continue existing reciprocal healthcare arrangements until at least 31 December 2020, the Government does recognise that as we leave the EU, arrangements may not be straightforward and people may experience some challenges. As such, while countries and individuals put arrangements in place, we have taken a number of steps to support and protect UK-insured individuals living in the EU.Not all UK-insured individuals will need to access these UK arrangements, as we may negotiate some further arrangements and many countries have put in place comprehensive arrangements already for UK-insured individuals and others may follow suit. However, coverage does vary, and the UK Government wants to ensure that all UK-insured individuals are in a good position to assess their options and prepare for what comes next.Specifically:(1) We have provided information online and are sending a letter to S1 holders living in EU and EFTA MS, encouraging individuals to consider their circumstances and options and to take the necessary steps to ensure they have appropriate coverage in place. The steps necessary will vary depending on individual’s circumstances and by country.(2) For UK-insured individuals who may find themselves in a particularly vulnerable situation because they fall ill before the UK leaves and require treatment that spans exit day, we have made specific transitional provisions. If an individual requires healthcare treatment before the UK leaves the EU and the treatment will continue until after Brexit, the UK Government will pay for this course of treatment for up to one year (or the authorised period in relation to an S2) or the period of treatment if shorter. This will apply for those receiving healthcare as an S1, S2 or as an EHIC holder.(3) The UK Government will fund the healthcare of existing UK-insured individuals living or working in the EU, on the same basis as now, for a further six months from the point of Brexit. This provision is aimed at providing individuals time to make alternative arrangements for their future healthcare cover, including registering for healthcare in their country of residence.The UK funded protection may be required if the EU or MS refuse to enter into arrangements with the UK or refuse to offer comprehensive protections to UK-insured through domestic legislation. In addition, some MS do not fund healthcare for those who are going through the healthcare registration process. To give as much protection as possible to UK-insured individuals, after the six months is over, the UK Government will continue to fund healthcare for the length of the registration period if that MS does not fund healthcare for that period (up to one year) and the individual has taken steps to register in-line with local timeframes and no later than six months from exit day. This will ensure there is appropriate coverage should there be delays or overly lengthy registration processes. If a UK-insured individual leaves their country of residence to travel to another country, they will have to take out full travel insurance as their EHIC will not be valid.(4) The UK will also continue to cover those travelling to the EU, whose visits commenced prior to Brexit day until they return to the UK, up to a period of six months.(5) Students may find themselves in a particularly challenging position if they are already studying abroad. All students are encouraged to take out comprehensive travel insurance and to investigate local healthcare schemes that they may be eligible for. However, given the circumstances, the UK Government has agreed to continue existing cover of healthcare costs for students for the duration of their course, should they be already studying in a MS at the point that the UK leaves the EU and on the basis of evidence from their Institution. More information on support for students can be found here: www.gov.uk/guidance/studying-in-the-european-union-after-brexit(6) In exceptional circumstances, the UK Government has put in place provisions to provide bespoke support to people who find themselves in a challenging position due to a change in their healthcare cover after Brexit. This scheme will run from 1st November 2019 for at least a year with strict criteria and will only support those with very limited financial means.The overall contingency package will be most relevant in MS whose domestic legislation does not protect UK-insured individuals during the registration period, exposing them to gaps in healthcare coverage and potentially high costs. We are seeking to agree with MS that they will accept our payments for healthcare cover if the UK leaves the EU without a deal. Where a MS does accept these payments, this would mean UK-insured individuals could continue accessing healthcare as now, beyond deciding whether to register with the local scheme or return to the UK within six months of Brexit. If a MS does not agree to this, then the UK Government will step in to pay healthcare costs directly. To access this support after the UK leaves the EU, UK-insured individuals will need to contact the NHS Business Services Authority (NHS-BSA) to provide them with the healthcare provider’s details, so that the BSA can arrange for the healthcare provider to invoice the UK Government directly.Individuals should not delay taking action to put appropriate permanent arrangements in place for when the UK leaves the EU on account of this additional support, particularly as for some EU countries the timeframe for UK-insured individuals to register with their domestic health system is far shorter than six months.Planned TreatmentThe UK Government will fund planned treatment within MS (S2 scheme) if authorisation for that treatment has been applied for before Brexit and later granted or authorised before Brexit, even if that treatment is scheduled to start after Brexit. The UK Government will pay for these treatments if the provider agrees to honour their commitment.Returning to the UKAfter the UK leaves the EU some people may decide to return the UK. UK nationals living in the EU whose healthcare is currently funded by the UK will be able to access free NHS care when temporarily visiting England, Scotland and Wales. UK nationals living in the EU will be eligible for NHS care if they move permanently back to the UK (including Northern Ireland) and meet the ordinarily resident test. Accident and Emergency services and services that are deemed urgent or immediately necessary will always be provided free at the point of delivery first in the UK, with entitlement to NHS care determined afterwards. More information can be found here: www.gov.uk/guidance/using-the-nhs-when-you-return-to-live-in-the-uk


This statement has also been made in the House of Lords: 
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Department for International Trade

Export Update

Elizabeth Truss: Statement on breaches of the undertaking given to the Court of Appeal not to grant new licences for export to Saudi Arabia of arms and military equipment for possible use in the conflict in YemenI want to update Parliament on matters relating to the two breaches of the Undertaking given to the Court of Appeal on 20 June by the then Secretary of State that we would not grant new licences for export to Saudi Arabia of arms and military equipment for possible use in the conflict Yemen, and the further breach of the commitment given to Parliament, also on 20 June, that we would not grant new licences for exports to Saudi Arabia or its Coalition partners which might be used in the conflict in Yemen.As the Government informed the Court on 16th September and followed up with an affidavit today, my Department identified errors that had taken place in the export licensing procedure in relation to the Saudi coalition’s activities in the conflict in Yemen.As I stated publicly on 16th September, I unreservedly apologise for the export licences that my Department issued in error. I have also given my unreserved apologies to the Court. A procedure to ensure that export licences were not granted for goods for Saudi Arabia and its Coalition partners for possible use in the conflict in Yemen was put in place on 20th June 2019. This followed the Court Order and the then Secretary of State’s statement to Parliament.The Export Control Joint Unit subsequently issued export licences to Saudi Arabia and its Coalition partners and, in line with the agreed procedure, these were signed off at official rather than Ministerial level.It subsequently came to light that two licences were in breach of the Court undertaking, and one licence was granted contrary to the statement in Parliament as these licences were for goods that could possibly be used in the conflict in Yemen. The first licence identified as raising this issue (Licence No. GBSIE2019/06449) was for the export of a single Wirewound Air Cooler, valued at £200, for incorporation by a French company, Arquus Defense SAS, in a Renault Sherpa Light Scout. Officials in ECJU have informed me that the licence application stated that the vehicle would be used by the Royal Saudi Land Forces (“RSLF”) in Saudi Arabia and they have provided me with the following information about this licence. This is in line with the formal role of the FCO and the MOD in providing advice on the Consolidated EU and National Arms Export Licensing Criteria (the “Consolidated Criteria”) to the DIT.Thereafter the sequence of events was as follows:On 3 June 2019, the FCO recommended approval on the basis that the RSLF were not operating in Yemen.On 4 June 2019, the MOD provided its advice recommending approval on the basis that the goods would not be used against the security or capability of the United Kingdom and that the equipment would not be diverted to an undesirable end-user.On 4 June 2019, the case was recirculated to the FCO who again, on 6 June 2019, provided its formal advice, recommending issue.On 18 June 2019, the FCO received information from the British Embassy in Riyadh that some RSLF troops were deployed in Yemen. Consequently, there was a risk that equipment destined for the RSLF might be used in the conflict in Yemen. The FCO was unaware that the licence had not already been issued and did not pass this information on to the DIT. We are investigating exactly how and when information was shared between FCO and DIT. In any event, it is plain that the DIT was not aware of the deployment of RSLF when the licence was formally countersigned and issued on 26 June 2019.The item was shipped and this licence is therefore now spent.Licence No. GBSIE2019/07556This licence was for the export of 260 items of various radio spares for the RSLF Signal Corps, valued at £435,450.Thereafter the sequence of events was:The application was circulated to the FCO and MOD on 31 May 2019.The FCO provided its advice recommending approval on 6 June 2019.The MOD advised approval on 26 July 2019.The licence was formally countersigned and issued on 29 July 2019.Given the fact that RSLF troops were being deployed in Yemen at the time the licence was issued, this licence should not have been granted.DIT officials have checked with the exporter: 180 items have been shipped, with a value of £261,450, leaving 80 items licensed but unshipped with a value of £174,000. DIT officials revoked this licence on 16 September 2019.Licence No. GBSIE2019/08983This is a licence for the temporary export for demonstration purposes of dual-use counter-improvised explosive device equipment. These goods remain under the exporter’s control at all times and so there is consequently no possibility that the equipment could be used in the conflict in Yemen. Consequently the licence is not within the scope of the Undertaking.Although not a breach of the Undertaking, one further licence was identified (Licence No. GBSIE2019/06671) that was granted for the export of equipment for which the end user was the UAE Navy, contrary to the statement to Parliament. Export Control Joint Unit officials cannot be sure that the relevant class of ship will be used solely for maritime security operations rather than in the conflict in Yemen. DIT officials revoked this licence on 16 September 2019 on the grounds that it was granted contrary to the Parliamentary Statement. Other licences have been issued to the UAE Navy that do not fall within the scope of the Parliamentary Statement.Without seeking to prejudge the independent investigation, it appears that information pertaining to the conflict had not been fully shared across government.As soon as the issue was brought to my attention on the 12th September, I took immediate action:Taking immediate steps to inform the Court and Parliament;Putting in place immediate, interim procedures to make sure the errors could not happen again;Instigating a complete and full internal review of all licences granted for Saudi Arabia and its Coalition partners since 20 June;The Permanent Secretary commissioned, on my behalf, a full independent investigation.The additional compliance processes comprise the following steps (in addition to the existing licensing processes):A checklist has been drawn up for licence applications for arms and military equipment to Saudi Arabia and its Coalition partners. This will be used by FCO and DIT officials when an export licence application is received for Saudi Arabia and/or any of the Coalition partners. It is intended to ensure that staff remain vigilant in considering the available information and in assessing whether the application potentially falls within the scope of the Undertaking and the Parliamentary Statement. A copy of this checklist is attached;Licence applications for arms and military equipment to Saudi Arabia and its Coalition partners will be referred to a new weekly meeting of senior officials from DIT, FCO and MOD. Some applications will have been refused by this point, for example where they fail to meet one or more of the Consolidated Criteria. This meeting will reach a recommendation for Ministers as to whether applications are within the scope of the Undertaking and the Parliamentary Statement, applying a further checklist of questions which are designed to ensure that: (i) current and full information is available to enable an assessment of whether the items in question are for possible use in the conflict in Yemen; and (ii) if there has been any change in circumstances in the conflict in Yemen, this is properly included in the assessment. A copy of this secondary checklist is attached;All recommendations to grant licences for the export of items to Saudi Arabia and its Coalition partners will be referred to Ministers.These additional compliance measures will be reviewed by the independent investigation, as well as kept under review by DIT to ensure that they are robust and appropriate.The full review of licences for Saudi Arabia and its coalition partners is currently being undertaken. This internal review is still ongoing.As a result of this internal review, we have identified one further licence that has been granted in breach of the Undertaking given to the Court of Appeal. Licence No GBOIE2019/00197 allowed the exporter, to return and repair electronic countermeasure improvised explosive device equipment licensed previously under three licences issued in 2014 (Licence Nos. GBSIE2014/010932; GBSIE2014/013148 and GBSIE2014/000512) to Saudi Eraad Defence Systems in Saudi Arabia (an agent of the RSLF). There are no new items being shipped under this licence. The equipment is deployed as an electronic countermeasure to prevent the triggering of a remotely controlled improvised explosive device.The process of approval for this licence was as follows:The application was received by DIT on 14 February 2019 and was circulated to the FCO, the National Cyber Security Centre at GCHQ (“GCHQ-NCSC”) and the MOD on 12 March 2019. It was circulated to GCHQ-NCSC for an assessment of whether the use of cryptography gave rise to any concerns.On 19 March 2019, GCHQ-NCSC advised that the application raised no concerns in relation to the use of cryptography.The FCO and MOD similarly recommended issue on 2 April and 16 July 2019 respectively.DIT countersigned the licence on 12 August and issued the licence on 13 August 2019. Given the fact that RSLF troops were being deployed in Yemen at the time the licence was issued, this licence should not have been granted.DIT officials contacted the exporter who confirmed that this licence has not been used. DIT officials revoked this licence on 20 September 2019.The licence has not been used and has now been revoked.My officials are also carrying out an urgent review of the composition of the Coalition. This has identified a further licence which is in breach of the Parliamentary statement. Licence No. GBOIE2016/00197b permits the export of fuel gauges for F-16 military aircraft to a number of countries which operate the F-16. The licence was originally granted on 5 August 2016 with an expiry date of 5 August 2019. On 28 August 2019 we extended the expiry date to 5 February 2020.We have re-assessed this licence in light of the latest information and subsequently revoked it in so far as it applies to Jordan. At the time the licence was extended, the relevant officials in ECJU believed Jordan was not involved in military operations in the conflict in Yemen.We have been able to confirm that none of the other recipient countries covered by this licence are Coalition partners.My officials are continuing to review all information relating to licences granted to Saudi Arabia and its Coalition partners since 20 June 2019 and we will be open and transparent with the Court and Parliament as to any new issues that emerge.In addition, the Permanent Secretary has commissioned, on my behalf, a full independent investigation. This will establish the precise circumstances in which these licences were granted, establish whether any other licences have been granted in breach of the Undertaking to the Court or contrary to the Parliamentary statement, and confirm that procedures are in place so that no further breaches of the Undertaking can occur. This investigation will be led by an independent senior official – the Director General of Policy Group in the Department for Work and Pensions.It is possible that more cases will come to light. As I have done so far, I will keep the Court and Parliament informed as to any new information that emerges.  CHECKLIST FOR CASE ASSESSMENT INVOLVING ARMS OR MILITARY EQUIPMENTThis is to be used by DIT and FCO licensing officers when an export licence application is received for Saudi Arabia and/or any of the Coalition Partners (CP). This checklist is in addition to the normal assessment against the Consolidated EU and National Arms Export Licensing Criteria (“the Consolidated Criteria”). If the assessment against the Consolidated Criteria identifies an application that should be refused, then it will follow the usual refusal procedure.DIT licensing officers must check to ensure that all the required information is available to enable a decision to be made as to whether Saudi Arabia and/or a CP destination is involved in the export. This will include asking the exporter for further information where they suspect that the final destination could be Saudi Arabia or a CP. This will then be recorded as a case note on SPIRE.FCO advisers must check to ensure that they are aware of the latest position on the conflict in Yemen, including the countries involved and the military forces involved. The FCO adviser, once in possession of the latest information, will carry out an analysis against this checklist. The analysis must be recorded on SPIREWhich countries are currently in the Coalition involved in the conflict in Yemen?Which military or government branches from Saudi Arabia or each CP are currently operating in the conflict in Yemen, so far as HMG is reasonably aware?IF A DIRECT EXPORT (TO ANY OF SAUDI ARABIA OR ITS COALITION PARTNERS):Is the consignee or end user a private/commercial enterprise with an industrial/civil/personal or private end use?IF YES – Please record analysis on SPIRE, including that it is not in scope of the undertaking to the Court or Parliamentary CommitmentIs the end user the civil police forces or emergency services of Saudi Arabia and/or a CP?IF YES - Please record analysis on SPIRE, including that it is not in scope of the undertaking to the Court or Parliamentary CommitmentIs the consignee or end user the armed forces of Saudi Arabia and/or a CP?IF YES – Please record analysis on SPIRE, including that it is potentially in scope of the undertaking to the Court or Parliamentary CommitmentIs that branch of the armed forces involved in the conflict in Yemen?IF YES - Please record analysis on SPIRE, including that it is potentially in scope of the undertaking to the Court or Parliamentary Commitment.IF AN INDIRECT EXPORT (TO ANY DESTINATION):Are the goods to be incorporated into equipment to be subsequently sold or delivered to the armed forces of a country whose forces are involved in the conflict in Yemen?IF YES – Please record analysis on SPIRE, including that it is potentially in scope of the undertaking to the Court or Parliamentary CommitmentThis licence application must be referred to the weekly DIT-FCO-MOD senior officials meeting CHECKLIST FOR DIT-FCO-MOD SENIOR OFFICIALS MEETINGEstablishing the operating context:Have all the licence applications for consideration in this meeting had full consideration against the Consolidated EU and National Arms Export Licensing Criteria (“the Consolidated Criteria”)?Which countries are currently part of the Coalition involved in the conflict in Yemen?Has any new country joined the Coalition?Has any country left the Coalition?Has the armed forces/branch of Saudi Arabia and Coalition Partners involved in the conflict in Yemen changed so far as HMG is reasonably aware?Has FCO confirmed that its advice, against the relevant criteria, is still up to date? (e.g. there is no information from Posts (or other reasonably available sources) that post-dates the advice entered onto SPIRE that may call into question the recommendation)Has MOD confirmed that its advice, against the relevant criteria, is still up to date?Assessing against the undertaking to the Court and the commitment to Parliament:Has each application been assessed against the terms of the undertaking to the Court and the commitment to Parliament?Is it clear that none of the applications involve arms or military equipment for possible use in the conflict in Yemen?The discussion in each meeting should be recorded on a template which is uploaded onto each relevant case on SPIRE. This will form part of the advice provided to Ministers after the meeting.


This statement has also been made in the House of Lords: 
HLWS1796